Commonwealth v. Chappell , 473 Mass. 191 ( 2015 )


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    SJC-11687
    COMMONWEALTH   vs.   DESHAWN CHAPPELL.
    Suffolk.       September 11, 2015. - November 23, 2015.
    Present:   Gants, C.J., Spina, Botsford, Duffly, & Hines, JJ.
    Homicide. Deoxyribonucleic Acid. Constitutional Law,
    Confrontation of witnesses, Fair trial. Evidence, Expert
    opinion, Consciousness of guilt, State of mind, Insanity.
    Witness, Expert. Insanity. Mental Health. Practice,
    Criminal, Capital case, State of mind, Confrontation of
    witnesses, Instructions to jury.
    Indictment found and returned in the Superior Court
    Department on March 24, 2011.
    The case was tried before by Jeffrey A. Locke, J.
    Stephen Neyman for the defendant.
    Matthew T. Sears, Assistant District Attorney (Edmund J.
    Zabin, Assistant District Attorney, with him) for the
    Commonwealth.
    BOTSFORD, J.    On January 20, 2011, Stephanie Moulton, a
    residential counsellor at a mental health facility in Revere,
    was killed while she was at work.     The defendant, a resident of
    the facility, was charged with her murder.     Principally at issue
    2
    at the defendant's subsequent jury trial was his mental state at
    the time of the killing; the defendant presented a defense of
    lack of criminal responsibility.    On October 28, 2013, the jury
    found the defendant guilty of murder in the first degree on the
    theory of deliberate premeditation.
    In his appeal from the conviction, the defendant argues
    that the trial judge erred by (1) permitting the Commonwealth to
    present evidence concerning deoxyribonucleic acid (DNA) testing
    through an expert witness who had not performed the DNA testing
    herself; (2) impermissibly limiting the direct examination of
    the defendant's primary mental health expert witness; (3)
    providing the jury with an inadequate instruction regarding the
    consequences of a verdict of not guilty by reason of lack of
    criminal responsibility; and (4) failing to limit the jury's
    consideration of evidence of consciousness of guilt solely to
    the issue of the defendant's mental state at the time the crime
    was committed.   He also requests relief under G. L. c. 278,
    § 33E.   We affirm the defendant's conviction, and after a
    thorough review of the record, we decline to grant relief
    pursuant to G. L. c. 278, § 33E.
    1.   Background.1   a.   The offense.   We summarize the facts
    the jury could have found.    Prior to January, 2011, the
    1
    We summarize here the evidence presented at trial
    concerning the killing of the victim and the defendant's
    3
    defendant was a resident of Perkins House, a moderate-intensity,
    residential mental health facility in the Charlestown section of
    Boston.2   Following an altercation between the defendant and
    another resident at that facility, the defendant was transferred
    temporarily to a respite program and, on January 3, 2011, he
    moved to Seagull House, a low-intensity group home in Revere for
    adults with mental illness.3   Seagull House staff helped
    residents to obtain basic social skills and skills required for
    residents eventually to be able to live on their own.   Seagull
    House was a "closed house," meaning that, between the hours of
    9 A.M. and 3 P.M., residents were not allowed to stay inside the
    facility but were expected to go to jobs or attend mental health
    group programs in the community.
    On January 20, 2011, despite the closed house policy, the
    defendant remained at Seagull House past 9 A.M. because he was
    scheduled to have a meeting at 1 P.M. with his "team," a group
    that included the victim and her supervisor, Colette
    criminal responsibility, reserving discussion of other evidence
    to our consideration of the legal issues raised.
    2
    Perkins House is a residential mental health facility
    operated by the North Suffolk Mental Health Association (North
    Suffolk), a nonprofit organization which contracts with the
    Department of Mental Health to provide mental health services to
    clients of the department.
    3
    Seagull House is another residential mental health
    facility operated by North Suffolk.
    4
    Deneumostier.4   Deneumostier arrived at Seagull House at
    approximately 8:30 A.M. on January 20, but left shortly
    thereafter to perform work-related errands.   The victim also
    arrived around the same time or a little later.   When the
    Seagull House staff member who had been in charge of the
    facility the previous night left sometime after 9 A.M., the
    victim and the defendant were the only two people remaining.     At
    approximately 10 A.M., Deneumostier spoke to the victim by
    telephone; at no point during that conversation did the victim
    report any concerns about the defendant's mental status.
    Deneumostier tried to contact the victim by telephone again
    several times before she (Deneumostier) returned to Seagull
    House at 11:30 A.M., but the calls went unanswered.
    When Deneumostier arrived at the facility, she heard the
    fire alarm sounding, saw smoke, and telephoned the Revere fire
    department or 911.   When fire fighters and police officers
    responded, they found no one inside the building, but they did
    observe a stove with two jets left on the high setting, one of
    which had smoke emanating from it; burnt paper on the kitchen
    4
    According to Colette Deneumostier, team meetings were
    typically set up shortly after a resident moved into Seagull
    House and began participating in its program. The purpose of
    the January 20, 2011, meeting of the defendant's team was to
    make sure the staff and he were "on the same page" and to
    address "some concerns with [the defendant] cooking at night,
    not doing his chore[s] all the time, [and] taking other people's
    food. And . . . to talk about his goals that were being set
    up."
    5
    floor; and charred debris in one of the bedrooms, including a
    gray, left boot.    In addition, there was a large amount of blood
    on the floor in the hallway, which appeared to be a drag mark
    that continued down the hallway and outside to the parking lot,
    where a spot of blood and a blood-soaked paper towel were found.
    Under the bed in the defendant's bedroom police found a crumpled
    note that stated:
    "Babycake, what ups? I still want to kick with you when I
    get something house next year. Are you down with that?
    How the kids? WB if you can. Can you go somewhere, kick
    with me, movies, out to eat?"
    Below that writing was a message in the victim's handwriting
    that read:   "Not just because I work here, but for many reasons,
    this is inappropriate."    Police also recovered from an office
    located in the lower portion of the building a green notebook
    that contained the victim's handwriting; at the time it was
    recovered, the notebook was opened to a page referencing the
    defendant.
    At approximately 12:30 P.M. the same day, the victim's body
    was found in the parking lot of St. George's Greek Orthodox
    Church (St. George's) in Lynn.5   The victim's pants and underwear
    were pulled down, and she was wearing one gray boot on her right
    foot that matched the left boot recovered from Seagull House;
    5
    The defendant had lived for a short period of time in 2005
    or 2006 in Lynn near to St. George's Greek Orthodox Church (St.
    George's), at a time when his then girl friend lived within
    walking distance of the church.
    6
    her left foot was bare other than a white sock.   The victim's
    body was covered with a bed sheet that came from the defendant's
    bedroom at Seagull House.   The victim had sustained sharp force
    injuries to her neck and blunt impact injuries to her head,
    torso, and upper extremities, but the cause of death was blood
    loss attributable to a long slash wound to the neck, which
    severed the sternocleidomastoid muscle, the jugular veins, and
    the carotid arteries.
    Video surveillance from St. George's dated January 20,
    2011, showed a vehicle, identified as belonging to the victim,
    enter the St. George's parking lot at approximately 11:32 A.M.,
    drive to the area where the victim was later found, and leave
    the parking lot at approximately 11:34 A.M.   The video recording
    also showed that, while the vehicle was parked, an individual
    stepped out of the driver's side, made a path around the rear of
    the vehicle to the passenger's side, returned to the driver's
    side, proceeded once more to the passenger's side, and
    eventually drove away.6
    Around 1 P.M. on January 20, 2011, the defendant visited a
    cousin in the Dorchester section of Boston and asked her for
    some money and a place to stay for a couple of days; he was
    6
    A resident of a building near to St. George's testified
    that at approximately 10 A.M. on January 20, 2011, she saw a man
    who fit the defendant's description in the parking lot. The
    witness saw the man bending over, but a snow bank blocked her
    view of the man's lower body.
    7
    unsuccessful in securing either one.   During the visit, the
    defendant's cousin saw a brown stain on the defendant's pants
    and a brownish or red stain on the defendant's sweatshirt, and
    she noticed that he kept his hands covered with his sleeves.
    When the defendant left the house, he was seen standing in front
    of the victim's vehicle, which he later abandoned.   After
    leaving his cousin's house, the defendant went to a clothing
    store where he stole a white hooded sweatshirt and a hat, and
    then traveled by train to Braintree and inquired about an
    extended-stay room at a hotel.   He then telephoned his
    grandmother, who lived in the Roxbury section of Boston, and
    asked if he could come to her house, insisting that he did not
    kill the victim and that his previous girl friend did,7 and later
    traveled by public transportation to the building where his
    grandmother lived.
    Police officers were waiting for the defendant in the lobby
    of his grandmother's building, his grandmother having informed
    the police of his impending arrival.   Following some resistance,
    the defendant was arrested and taken into custody.   Police
    officers handcuffed the defendant and placed him in a chair in
    the lobby.   While the defendant was seated, and as a police
    7
    Prior to the defendant's telephone call, his grandmother
    had seen the television news regarding the killing of the victim
    in Revere. When she spoke to the defendant during his call, she
    told him that she heard that the television news coverage about
    the killing in Revere involved him.
    8
    officer was administering Miranda warnings to him, the defendant
    blurted out, "The Chinese kid did it."   The defendant did not
    otherwise exhibit bizarre or psychotic behavior or appear or
    sound delusional during the time he was in the lobby.
    The defendant was transported to a Boston police station
    and then to the police station in Revere.   During the trip to
    Revere, the defendant was quiet and calm, but crying, and when
    asked if he was all right, he said that people had been chasing
    him all day with guns and that he was worried for his family.
    He was asked if he knew why he was in police custody, and he
    responded that it was "because of what happened at the house."
    Testing of a sample of blood located on fingernail scrapings
    taken from the defendant's right hand revealed that the sample
    contained a mixture of DNA from at least two individuals.    The
    major profile identified matched the defendant, and the victim
    was included as a potential contributor to the minor profile.
    b.   The defendant's mental state and criminal
    responsibility.   The defendant was thirty at the time of trial
    in October, 2013.   According to his mother and grandmother,
    while in high school, the defendant had regularly attended
    school and church, was outgoing and well-dressed, played sports,
    and worked at a part-time job.   He graduated from high school
    around 2002 and worked as a sales person at a clothing store and
    then as a bar back at a convention center in Boston.    Around
    9
    2004, his mother noticed that he no longer cared about his
    appearance and that he had become withdrawn.    The defendant
    began to have trouble sleeping and would call his mother
    regularly in the middle of the night, asking why he was hearing
    voices in his head.    He also stopped attending weekly family
    dinners at his grandmother's house.
    The defendant was first hospitalized in 2006, after he
    informed his mother that he wanted to go to the hospital because
    he felt that he might hurt someone.    His mother took him to the
    emergency department of Massachusetts General Hospital (MGH),8
    and personnel at MGH kept the defendant for observation for two
    to three weeks.    When he was discharged, he went to live with
    his grandmother.    He was prescribed medication, which he
    eventually stopped taking because the side effects caused him
    difficulties with swallowing and speaking, and also caused
    involuntary tremors.    Only months after the first instance, the
    defendant was again hospitalized at MGH.    Around 2006, he was
    diagnosed with schizophrenia9 and, in that year, became a client
    of the Department of Mental Health (department).    In 2006 and
    2007, the defendant was hospitalized briefly at Whidden Memorial
    8
    The defendant's mother was employed by Massachusetts
    General Hospital as an operations associate.
    9
    Schizophrenia is a mental illness that is long-standing in
    duration, and symptoms of the illness include disorganized
    thoughts and perception, delusions, and auditory and visual
    hallucinations.
    10
    Hospital.      From 2006 to 2009, the defendant lived primarily with
    his grandmother.      According to his grandmother, the defendant's
    mental health condition deteriorated during that period, even
    though he resumed taking medication.      For example, the defendant
    was hearing voices and he tried to get the voices out of his
    head by eating large amounts of food and by trying to burn them
    out.    At one point, he also became too frightened to leave the
    house.      In 2009, the defendant was hospitalized at MGH for a
    third time, after which he went to Bridgewater State Hospital
    (Bridgewater) for three weeks.      Around 2009, the defendant was
    placed at Perkins House, and in late 2009, he was hospitalized
    at Arbor Hospital.      The defendant was hospitalized for
    psychiatric reasons on at least five occasions between 2006 and
    the day the victim was killed in January, 2011; the final
    hospitalization ended in December, 2009.
    David Thomson, a program coordinator employed by North
    Suffolk Mental Health Association (North Suffolk), first met the
    defendant when he was a resident of Perkins House.      Thomson made
    referrals of the defendant to the Boston Emergency Services Team
    (BEST)10 in October, 2009, and in July and September, 2010,
    because the defendant appeared disorganized and was
    decompensating on these dates.      The defendant's medical record
    10
    The Boston Emergency Services Team (BEST) is a team of
    mental health clinicians who respond to emergency calls to
    perform crisis evaluations.
    11
    at North Suffolk indicated that on the date of the July, 2010,
    BEST referral, he had an increase in hallucinations, felt
    paranoid, believed that members of the staff were listening to
    his conversations, and made verbal outbursts regarding the
    taking of his powers.   That record also reflected that the
    defendant had a history of traumatic brain injuries, lead
    poisoning, and substance abuse.
    Michael Swinchoski, a licensed mental health counsellor
    employed by North Suffolk, first met the defendant in 2007.
    Swinchoski believed the defendant suffered from disorganized
    schizophrenia, and that he responded to an inner stimulus
    unprompted by any external circumstances.    In December, 2010,
    and January, 2011, Swinchoski was working with the defendant in
    an attempt to allow him to live in his own apartment, which
    Swinchoski thought would help reduce the defendant's level of
    stress and, thus, ameliorate his symptoms.    On January 19, 2011,
    one day before the killing, Dr. Daniel Debowey, a psychiatrist
    employed part-time by North Suffolk, met with the defendant for
    the first time; Debowey was going to become the defendant's new
    psychopharmacological treater.    During the meeting, the
    defendant was wearing socks on his hands, which Debowey noted
    because he knew that the defendant had been diagnosed with
    schizophrenia or schizoaffective disorder and, at times, bizarre
    elements of clothing can be a sign of relapse.    However, the
    12
    defendant did not report any auditory hallucinations, nor did he
    appear to be responding to internal stimuli, and Debowey was not
    left with the impression that the defendant posed an acute risk
    to himself or others.
    On January 21, 2011, one day after the victim was killed,
    Dr. Naomi Leavitt, a forensic psychologist employed by the
    department, conducted a court-ordered competency evaluation of
    the defendant.   In Leavitt's opinion, the defendant failed to
    understand her explanation of the fact that what he said to her
    would not be confidential, and made statements not reflective of
    reality including that he did not have a mother, that he had
    only finished the first grade, that he had never been in a
    psychiatric hospital or been diagnosed with a mental illness,
    that there were "rascals" out to hurt him, and that he would
    wake up in the morning with bruises on his body.   During the
    evaluation, the defendant became increasingly agitated.     Leavitt
    questioned the defendant's competence to stand trial and
    recommended that he be further evaluated at Bridgewater.     A few
    weeks thereafter, Dr. Charles Carroll, the director of forensic
    services and psychology at Bridgewater, performed two
    assessments of the defendant's competence to stand trial and his
    need for further hospitalization.   Carroll diagnosed the
    13
    defendant with schizophrenia, undifferentiated type.11   Carroll
    opined that the defendant was not competent to stand trial due
    to thought disorganization related to his mental illness and
    that the defendant required further hospitalization.
    The defendant's primary mental health expert at trial was
    Dr. David Werner, a psychologist.   Werner met with the defendant
    on three occasions and reviewed the multiple medical and
    psychiatric records of the defendant, including records of all
    the defendant's hospitalizations, and police reports; he also
    interviewed family members.   Based on his personal meetings and
    review of the data, Werner diagnosed the defendant with paranoid
    schizophrenia.   Werner opined that the defendant suffered from
    hallucinations and delusions that made him unable to distinguish
    between voices in his head and memories of a person's voice, and
    that the defendant had been decompensating since July, 2010.
    The defendant told Werner that on January 20, 2011, he (the
    defendant) heard a voice telling him to kill the victim and
    therefore he choked her, and when he thought that she was still
    alive, he obtained a knife and inflicted the wounds that caused
    her death.   Werner ultimately concluded that the defendant was
    not criminally responsible for his acts on January 20, 2011,
    because he could not conform his conduct to the law at that
    11
    Undifferentiated type means that the affected person
    presents with symptoms of various other subtypes of
    schizophrenia.
    14
    time.   In Werner's view, the defendant's attempts to conceal the
    crime after the fact were consistent with the conclusion that
    the defendant could not conform his conduct to the law because
    those attempts were so completely disorganized and ineffective.
    The Commonwealth's expert witness, Dr. Martin Kelly, a
    psychiatrist, conducted a criminal responsibility examination of
    the defendant and opined that, at the time of the killing, the
    defendant did not suffer from a mental disease or illness that
    interfered with his ability to appreciate the wrongfulness of
    his conduct or conform his conduct to the law.   According to
    Kelly, when a person actually experiences auditory
    hallucinations, the hallucinations are part of a larger,
    consistent, delusional system or "back story."   Kelly opined
    that, although the defendant claimed to experience auditory
    hallucinations that caused him to kill the victim, the
    hallucinations were not part of a larger delusional system and
    were probably made up.   Kelly's opinion was also based on his
    view that the defendant's self-interested acts to try to cover
    up the crime and his participation in it demonstrated that the
    defendant had the capacity to appreciate the wrongfulness of his
    conduct.   Finally, in reviewing the records and notes prepared
    by the North Suffolk mental health staff and clinicians who had
    seen and interacted with the defendant from July, 2010, to
    15
    January, 2011, Kelly observed no decompensation by the
    defendant.
    Discussion.   1.   Substitute DNA expert.   On appeal, the
    defendant argues that his constitutional right of confrontation
    guaranteed by the Federal and State Constitutions was violated
    when the Commonwealth's DNA expert, Lynn Schneeweis, was
    permitted to testify about the results of DNA testing performed
    by another analyst, Sarah Hughes, who was no longer employed by
    the State police crime laboratory (crime lab) at the time of
    trial and was not available to testify.12   The argument fails.
    Schneeweis held a master's degree in forensic science, was
    a trained DNA analyst, and also was the section manager for
    forensic biology at the crime lab, overseeing six or seven of
    the crime lab's units, including the criminalistics and crime
    scene units and the DNA unit.    Within the DNA unit, she
    supervised approximately twenty-five to thirty DNA analysts.
    Schneeweis described in her testimony the process by which the
    crime lab conducts DNA analysis, including the specific
    protocols used.    Although Schneeweis did not perform the
    preliminary analysis of the DNA evidence in this case, she was
    the "technical reviewer" and "second reader" of the DNA analysis
    performed by Hughes.    A technical reviewer "is responsible for
    12
    Immediately before trial, the Commonwealth filed a motion
    in limine to permit Lynn Schneeweis to testify, rather than
    Sarah Hughes, who was in England. The judge allowed the motion.
    16
    . . . going through the file and making sure that everything was
    done in accordance with policy and procedure, and that the
    conclusions that the analyst[] draws are supported by the data
    that was generated during the analysis procedure," and
    Schneeweis performed this work in the present case.   As the
    second reader, Schneeweis independently read all the raw data
    and the reports produced by Hughes, made interpretations, and
    ensured that there was agreement between her findings and those
    of Hughes.   After explaining in some detail the specific work
    that she herself had performed, Schneeweis testified to her
    opinions or conclusions13 concerning the DNA that had been
    collected.   In particular, as stated earlier, she opined that
    that the major profile identified in the DNA sample taken from
    the fingernail scrapings of the defendant's right hand matched
    the defendant, and the victim was included as a contributor to
    the minor profile of the DNA mixture contained in this sample.14
    13
    With few exceptions, in his direct examination of
    Schneeweis, the prosecutor asked the witness for her
    "conclusions" rather than "opinions," but in the context it is
    clear that the prosecutor was using the two words
    interchangeably.
    14
    The fingernail scrapings were the only deoxyribonucleic
    acid (DNA) sample that included the defendant and the victim as
    possible contributors. There was no male DNA detected on swabs
    and scrapings collected from the victim's underpants, and
    therefore, testing of that DNA sample was ended. In addition,
    samples from reddish-brown stains on the defendant's sweatshirt
    and from the victim's hands were submitted for DNA analysis and
    the defendant was excluded from both as a potential contributor.
    17
    In addition, based again on her own independent work, she
    testified to her opinion that the probability of a random,
    unrelated individual contributing to the DNA mixture of the
    minor profile was approximately one out of 494,400 of African-
    Americans, one out of 242,800 of Caucasians, one out of 314,400
    of Hispanics, and one out of 3,204,000 of Asians.
    At trial, the defendant objected at the outset of
    Schneeweis's testimony generally on confrontation and chain of
    custody grounds;15 with respect to confrontation, he argued that
    Schneeweis could not testify to any opinions or conclusions
    regarding the DNA evidence because she did not personally
    conduct the laboratory examination and analysis of that
    evidence.   The trial judge overruled the objection.   The parties
    appear to disagree about whether the defendant's confrontation
    argument on appeal is the same or different from his trial
    objection -- an issue that bears on the standard of review to be
    applied -- but we need not resolve the point, because the judge
    committed no error in permitting Schneeweis to testify or with
    respect to any of the particulars of her testimony.
    With regard to a defendant's right of confrontation, as the
    defendant recognizes, we have permitted experts to rely on and
    testify to their own opinions based on "the results of tests,
    15
    The defendant does not raise any argument concerning
    chain of custody on appeal, and in any event, our review reveals
    no error.
    18
    experiments, or observations conducted by another" since
    Department of Youth Servs. v. A Juvenile, 
    398 Mass. 516
    , 532
    (1986), decided nearly thirty years ago.   See Commonwealth v.
    Barbosa, 
    457 Mass. 773
    , 784-785, 790 (2010), cert. denied, 
    131 S. Ct. 2441
     (2011).    Cf. Commonwealth v. Nardi, 
    452 Mass. 379
    ,
    383, 389-391 (2008) (opinions of substitute medical examiner
    based on autopsy report and photographs relating to autopsy that
    he did not perform).   The critical issue with respect to an
    expert, including in particular a DNA analyst, is whether the
    defendant is able to cross-examine the expert in a meaningful
    way regarding possible flaws relating to the underlying data
    that forms the basis of his or her opinion.   See Barbosa, 
    supra at 790-791
    .   Compare Commonwealth v. Greineder, 
    464 Mass. 580
    ,
    594-599, cert. denied, 
    134 S. Ct. 166
     (2013) (defendant had
    meaningful opportunity to cross-examine Commonwealth's expert
    about reliability of data), with Commonwealth v. Tassone, 
    468 Mass. 391
    , 399, 401-402 (2014) (defendant could not meaningfully
    cross-examine Commonwealth's expert witness where DNA was
    analyzed at different laboratory in different State from where
    expert worked).16
    16
    We have recognized that for DNA evidence in particular,
    "the testing techniques are so reliable and the science so sound
    that fraud and errors in labeling or handling may be the only
    reasons why an opinion is flawed" (emphasis in original).
    Commonwealth v. Barbosa, 
    457 Mass. 773
    , 790 (2010), cert.
    denied, 
    131 S. Ct. 2441
     (2011). See Commonwealth v. Tassone,
    
    468 Mass. 391
    , 400 (2014).
    19
    Similar to the defendant in Barbosa, 
    457 Mass. at 791
    , and
    particularly like the defendant in Greineder, 464 Mass. at 597-
    598, the defendant here certainly was able to cross-examine the
    Commonwealth's expert Schneeweis meaningfully about the
    reliability of the underlying DNA testing procedures and data,
    given that Schneeweis was the crime lab's section manager for
    forensic biology and supervisor of the crime lab's DNA analysts
    (including Hughes) and had been directly involved in this case
    as the second reader and technical reviewer; in those capacities
    she had reviewed both the raw DNA data produced by the crime
    lab's analytic instruments and the DNA samples themselves.   The
    defendant does not claim otherwise, but asserts, based on one
    statement made by Schneeweis during her direct examination,17
    that all Schneeweis did was to parrot and repeat for the jury
    Hughes's conclusions.
    The defendant is correct that under Massachusetts law, an
    expert witness is not permitted to testify on direct examination
    to facts or data that another, nontestifying expert has
    generated, or to the nontestifying expert's own opinion, even
    though this information may be an important part of the basis of
    the testifying expert's opinion.   See, e.g., Greineder, supra at
    592, 601-602.   See also Barbosa, 
    457 Mass. at 785
    ; Nardi, 452
    17
    Schneeweis testified that, as part of her review of
    Hughes's work in this case, she, Schneeweis, determined whether
    "the conclusions that were generated by [Hughes were] supported
    by the data generated during the analysis procedures."
    20
    Mass. at 390-391; Mass G. Evid. § 703 (2015).   But we see no
    indication in Schneeweis's testimony, including the portion of
    her testimony to which the defendant points (see note 17,
    supra), that Schneeweis at any time described any part of
    Hughes's DNA analysis or of Hughes's testing results, opinions,
    or conclusions.   Rather, Schneeweis described the analytic
    process that Hughes, as an analyst in the crime lab, would have
    followed, and Schneeweis's own opinions that she had formed
    independently and directly from the case review and analysis she
    herself had performed.   Schneeweis's testimony was admissible in
    all respects, and the judge did not err in admitting it.
    2.   Limited direct examination of defendant's primary
    mental health expert.    At trial, the defendant's counsel argued
    that the defendant' mental health experts, and in particular Dr.
    Werner, were permitted under our case law to testify on direct
    examination about the contents of the defendant's medical
    records, including medical diagnoses and opinions about the
    defendant's mental state that the expert had read and may have
    relied on in forming the expert's own opinion, even though the
    records themselves were not in evidence and the defense did not
    wish to introduce them in evidence.18   The trial judge
    18
    In support of this argument, the defendant cited to the
    trial judge a number of decisions of this court, including
    Commonwealth v. Greineder, 
    464 Mass. 580
    , cert. denied, 
    134 S. Ct. 166
     (2013); Commonwealth v. Nardi, 
    452 Mass. 379
     (2008);
    Commonwealth v. Markvart, 
    437 Mass. 331
     (2002); Commonwealth v.
    21
    disagreed,19 but pointed out that if the defense introduced the
    defendant's medical records in evidence as an exhibit, Werner
    (and any other expert) would then be entitled to testify
    concerning any opinions or other information contained in them.
    The defendant's counsel chose not to introduce the medical
    records, in part because of the voluminous quantity and the
    difficulty he perceived in the jury's attempting to wade through
    them.
    On appeal, the defendant repeats the claim that it was
    error to preclude Werner from testifying, during his direct
    examination, to opinions about the defendant's mental illness
    and mental status more generally that were contained in his
    medical records.   He does not focus his argument on the right of
    confrontation guaranteed by the Sixth Amendment to the United
    States Constitution and art. 12 of the Massachusetts Declaration
    of Rights, but contends that this limitation violated his
    separate right to present a defense that is protected by these
    same constitutional guarantees.   We disagree.
    Waite, 
    422 Mass. 792
     (1996); and Department of Youth Servs. v. A
    Juvenile, 
    398 Mass. 516
     (1986).
    19
    The judge explained: "I think Greineder makes clear that
    the basis for one's opinion is properly the subject of cross-
    examination, but is not generally admissible as part of direct
    examination. . . . And if the Commonwealth does cross-examine
    him on any basis for opinion[,] that then permits you on
    redirect to explore whatever the sources of information that he
    used were."
    22
    In Department of Youth Servs. v. A Juvenile, 
    398 Mass. at 531
    , we ruled for the first time that an expert may "base an
    opinion on facts or data not in evidence if the facts or data
    are independently admissible and are a permissible basis for an
    expert to consider in formulating an opinion."    However, that
    case also makes clear that although an expert may rely on facts
    or data that have not been admitted but would be admissible in
    evidence, the expert may not testify to the substance or
    contents of that information on direct examination.     
    Id.
       See
    Tassone, 468 Mass. at 399 ("Our evidentiary rules permit the
    facts or data underlying the opinion to be elicited only by the
    defendant on cross-examination and, where this door has been
    opened by the defendant, by the prosecution on redirect
    examination").20   The defendant points out that our cases
    discussing this rule have done so in the context of a
    Commonwealth expert witness, where it is the Commonwealth that
    is precluded from asking the expert on direct examination to
    testify to the content of data or even opinions generated or
    held by others, and the cases have emphasized that the rationale
    for the rule is to protect defendants from the admission of
    hearsay evidence by the Commonwealth.   See, e.g., Greineder, 464
    Mass. at 592-594; Barbosa, 
    457 Mass. at 785
    .     The defendant
    20
    Several cases following Department of Youth Servs. v. A
    Juvenile, 
    398 Mass. at 531
    , have reaffirmed this limitation.
    See, e.g., Greineder, 464 Mass. at 583-584; Markvart, 437 Mass.
    at 337-338.
    23
    contends that, where the defendant who seeks to ask his or her
    own expert witness about the bases for the expert's opinion, the
    interests are different, and the defendant's ability to present
    a defense is materially impaired if the expert is not permitted
    to explain those bases by pointing to admissible, but not
    admitted, evidence that the expert has reviewed and relied on.
    The limitation just discussed on the direct examination
    testimony of an expert witness is a common-law evidentiary rule
    that operates in both civil and criminal cases and applies to
    both sides.   See Department of Youth Servs. v. A Juvenile, 
    398 Mass. at 531-532
    ; Mass. G. Evid. § 703.   See also Vassallo v.
    Baxter Health Care, 
    428 Mass. 1
    , 15-16 (1998); Commonwealth v.
    Waite, 
    422 Mass. 792
    , 803 (1996).   "A defendant's right to
    present a full defense . . . is not without limits," United
    States v. Bifield, 
    702 F.2d 342
    , 350 (2d Cir.), cert. denied,
    
    461 U.S. 931
     (1983), and as a general rule, "does not entitle
    him to place before the jury evidence normally inadmissible"
    (quotation omitted).   United States v. Yousef, 
    327 F.3d 56
    , 128
    (2d Cir.), cert. denied, 
    540 U.S. 933
     (2003).   See United States
    v. Anderson, 
    872 F.2d 1508
    , 1519 (11th Cir.), cert. denied, 
    493 U.S. 1004
     (1989).   There is no reason to apply an exception to
    our evidentiary rule in this case, particularly because, as the
    judge stated to the defendant's trial counsel, he would have
    been able to elicit from the defense expert on direct
    24
    examination the opinions and other information from the
    defendant's medical records in which he was interested by first
    introducing those medical records in evidence.    See Mass. G.
    Evid. § 703.    That counsel did not wish to follow this path for
    strategic reasons does not transform the generally applicable
    evidentiary requirement into an unconstitutional burden placed
    on the defendant.21
    3.    Mutina instruction.   At trial, the defendant asked for
    a jury instruction about the consequences of a verdict of not
    guilty by reason of lack of criminal responsibility (Mutina
    instruction).    See Commonwealth v. Mutina, 
    366 Mass. 810
    , 823 &
    n.12 (1975).    The defendant's request, however, was that the
    judge modify the Mutina instruction that is part of the Model
    Jury Instructions on Homicide (2013) in several respects; most
    substantively, he sought the addition of language that would
    inform the jury that if the defendant were still suffering from
    a mental illness and still dangerous, "[t]here is no limit to
    additional commitments [following the initial commitment of six
    months] and the defendant could be committed for the rest of his
    life."22   The judge did not adopt the defendant's proposed
    21
    Furthermore, the record shows that the defendant's expert
    was permitted, on direct and cross-examination, to testify at
    length to specific aspects of the defendant's medical and
    treatment records.
    22
    The instruction proposed by the defendant's trial counsel
    also would have added to the model instruction a statement that
    25
    instruction, but gave the model Mutina instruction.   See Model
    Jury Instructions on Homicide, supra at 11-12.
    On appeal, the defendant argues that the judge's Mutina
    instruction created a substantial likelihood of a miscarriage of
    justice.   He claims that by including references to the number
    of days the defendant might be committed for observation and
    also referencing the initial six-month commitment without a
    mention of the possibility that the defendant could remain
    committed for the rest of his life, the instruction was unfairly
    one-sided, underestimated the likely period of commitment the
    defendant would face, and was likely to distract the jury from
    their essential fact-finding role.   The information about the
    consequences of a verdict of not guilty by reason of lack of
    criminal responsibility included in the judge's Mutina
    instruction, however, was accurate; the judge did not err in
    giving it in response to the defendant's request for a Mutina
    charge.    See Commonwealth v. Johnston, 
    467 Mass. 674
    , 702-703
    (2014).    Nonetheless, the core of the defendant's criticism --
    that the model Mutina instruction underestimates the potential,
    and in the defendant's view, likely, length of confinement of a
    defendant found not criminally responsible -- is one that has
    if the jury found the defendant guilty of murder in the first or
    second degree, he would be sentenced to State prison, not a
    mental health facility. The defendant does not press the point
    on appeal, and we find no persuasive reason to add this
    language.
    26
    been raised as a matter of concern over the years, see, e.g.,
    Johnston, 467 Mass. at 701-702; Commonwealth v. Callahan, 
    380 Mass. 821
    , 826-827 (1980), S.C., 
    386 Mass. 784
     (1982), and S.C.,
    
    401 Mass. 627
     (1988); Commonwealth v. Loring, 
    14 Mass. App. Ct. 655
    , 659-660 (1982), and warrants our consideration.
    In the Mutina case itself, this court did not prescribe or
    even suggest any specific form of instruction.   Moreover, the
    court has made clear that a Mutina instruction need not mention
    the specific time periods for observation or commitment that are
    included in the civil commitment statutes.23   See Callahan, supra
    at 827-828.   A Mutina instruction is designed to avoid
    unnecessary speculation by the jury and ensure that they
    comprehend the possible consequences of a verdict of not guilty
    by reason of lack of criminal responsibility -- and in
    particular, to understand "what protection they and their fellow
    citizens will have if they conscientiously apply the law to the
    evidence and arrive at a verdict of not guilty by reason of
    [lack of criminal responsibility] -- a verdict which necessarily
    requires the chilling determination that the defendant is an
    insane killer not legally responsible for his acts."      See
    Mutina, 
    366 Mass. at 821-822
    .   On reflection, we think an
    instruction that omits references to specific time frames for
    observation and mentions the potential for successive commitment
    23
    See G. L. c. 123, §§ 7, 8, 15 (b), 15 (e), 15 (f), 16, 18
    (a), and 18 (c).
    27
    orders that could span the duration of the defendant's life in a
    context that accurately reflects the law governing such
    commitments may better accomplish these purposes.    Accordingly,
    we propose a provisional instruction along the lines set forth
    in an Appendix to this opinion.24
    4.   Instruction on consciousness of guilt.    The defendant
    requested that the trial judge omit a jury instruction on
    consciousness of guilt because the defense "pretty much
    stipulated that [the defendant] committed the homicide" and was
    "not contesting it."   The judge denied the request, reasoning
    that there was no actual stipulation that the defendant had
    committed the homicide, and therefore the burden remained on the
    Commonwealth to prove beyond a reasonable doubt that the
    defendant did so, and a consciousness of guilt instruction was
    therefore pertinent and appropriate.
    On appeal, the defendant's argument is more nuanced.    He
    does not contend that a consciousness of guilt instruction
    should have been omitted in its entirety but rather that the
    judge, in exercising discretion to give such an instruction,
    24
    With the assistance of a committee of trial court judges,
    this court currently is reviewing the Model Jury Instructions on
    Homicide that were published in 2013. The proposed instruction
    set out in the Appendix is a possible form of a revised Mutina
    instruction, but we invite the committee to review and, if
    appropriate, propose revisions to this proposed instruction.
    For the present, upon request by a defendant, a judge should
    give the provisional Mutina instruction set forth in the
    Appendix.
    28
    committed reversible error in not limiting the jury's
    consideration of consciousness of guilt evidence to the issue of
    the defendant's mental state at the time of the crime, i.e., his
    criminal responsibility or lack thereof.   We do not agree.     As
    the trial judge noted, although the defendant did not contest
    that he had killed the victim, the Commonwealth was still
    required to prove beyond a reasonable doubt that he did so and
    the evidence of consciousness of guilt was relevant to this
    question.   See Commonwealth v. Lowe, 
    391 Mass. 97
    , 108 n.6,
    cert. denied, 
    469 U.S. 840
     (1984) (evidence of consciousness of
    guilt is relevant to whether homicide occurred).   Cf.
    Commonwealth v. Denis, 
    442 Mass. 617
    , 624 (2004) (no error for
    judge to give identification instruction, although
    identification not contested; necessary for Commonwealth to
    prove beyond reasonable doubt identification of defendant as
    person who committed crime, notwithstanding concessions by
    defense at trial).   Moreover, as the defendant's argument on
    appeal recognizes, actions taken by the defendant following the
    killing of the victim that reasonably could be interpreted to
    reflect consciousness of guilt25 were relevant to an assessment
    of the defendant's mental state and whether he was criminally
    25
    Such acts included, for example, setting a fire in
    Seagull House, arguably seeking to burn evidence of or even burn
    down the locus of the killing; wrapping and discarding the
    victim's body in a church parking lot removed from the scene of
    the killing; stealing and changing into different clothes; and
    trying to secure a place to stay with relatives and out of view.
    29
    responsible.   Accordingly, an instruction on consciousness of
    guilt was entirely proper in the circumstances of this case.
    See Commonwealth v. Cardarelli, 
    433 Mass. 427
    , 437 (2001).
    5.   Relief under G. L. c. 278, § 33E.    The defendant argues
    that, based on the extensive evidence of his mental illness
    presented at trial, this court should exercise its power of
    review under G. L. c. 278, § 33E, to reduce the degree of guilt
    or order a new trial.    We recognize that the defendant presented
    substantial evidence that he lacked criminal responsibility at
    the time he killed the victim.   However, the Commonwealth
    presented substantial evidence to the contrary.   The jury were
    entitled to reject the testimony and opinions of the defendant's
    witnesses and instead credit the contrary evidence, including
    the opinion of the Commonwealth's expert, and to conclude that
    the defendant was criminally responsible.    "Tragic as this case
    is, it is a case where the question of criminal responsibility
    was truly for the jury, and justice does not require that their
    verdict be disturbed."    Johnston, 467 Mass. at 706.   In the
    circumstances of this case, based on our careful review of the
    trial record, we decline to reduce the degree of guilt, order a
    new trial, or grant other relief under G. L. c. 278, § 33E.
    Judgment affirmed.
    Appendix.
    PROVISIONAL MUTINA INSTRUCTION1
    Consequences of Verdict of Not Guilty by Reason of Lack of
    Criminal Responsibility. As I have previously instructed, your
    decision should be based solely on the evidence and the law of
    this case, without regard to the possible consequences of the
    verdict[s]. You may not consider sentencing or punishment in
    reaching your verdict[s]. However, I am going to tell you what
    happens to a defendant if he [or she] is found not guilty by
    reason of lack of criminal responsibility.
    First, the court may order the defendant to be hospitalized
    at a mental health facility for a period of observation and
    examination. During this observation period or in any event
    within sixty days after a verdict of not guilty by reason of
    lack of criminal responsibility, the district attorney or other
    appropriate authorities may petition the court to commit the
    defendant to a mental health facility or to Bridgewater State
    Hospital. If the court concludes that the defendant is mentally
    ill and that his [or her] discharge would create a substantial
    likelihood of serious harm to himself [or herself] or others,
    then the court will grant the petition and commit the defendant
    to a proper mental facility or to Bridgewater State Hospital,
    initially for a period of six months. At the end of the six
    months and every year thereafter, the court reviews the order of
    commitment. If the defendant is still suffering from a mental
    disease or defect and is still dangerous, then the court will
    order the defendant to continue to be committed to the mental
    facility or to Bridgewater State Hospital. There is no limit to
    the number of such renewed orders of commitments as long as the
    defendant continues to be mentally ill and dangerous; if these
    conditions do continue, the defendant may remain committed for
    the duration of his [or her] life.
    If at some point the defendant is no longer mentally ill
    and dangerous, the court will order him [or her] discharged from
    the mental health facility or from Bridgewater State Hospital
    after a hearing. The district attorney must be notified of any
    hearing concerning whether the person may be released, and the
    district attorney may be heard at any such hearing. However,
    the final decision on whether to recommit or release the
    defendant is always made by the court.
    1
    See Commonwealth v. Mutina, 
    366 Mass. 810
    , 823 & n.12
    (1975).
    2
    This is what happens if you find the defendant not guilty
    by reason of lack of criminal responsibility.